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COUNTY OF ALBEMARLE
Department of Engineering
401 McIntire Road,Room 211
Charlottesville,Virginia 22902-4596
(434)296-5861
CONVERSION to PERMANENT SWM FACILITY FORM
PROJECT NAME: Townwood Mobile Home Park
TMP: 61 - 8
SITE PLAN NUMBER: 2132
FACILITY TYPE(S): extended detention pond &2 underground detention facilities
DATE: 17-Jun-04
This project has been satisfactorily completed, the Stormwater Management portion of
the Water Protection Bond can be released.
Water Resources Personnel: Markent portiAl
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Date: C
7-- CIU.-1 — 61
Copy: Pam Shifflett
File: I:ADept\Engineer\Forms\Soil Erosion\Conversion to Permanent SWM Facility Form
FAX(434)972-4035
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COUNTY OF ALBEMARLE
Department of Engineering & Public Works
401 McIntire Road,Room 211
Charlottesville, Virginia 22902-4596
(804) 296-5861
Fax (804) 972-4035
WATER PROTECTION ORDINANCE
GENERAL APPLICATION FORM
CHECK TYPE OF PLAN INCLUDED WITH APPLICATION:
'.i EROSION & SEDJMI NT CONTROL PERMIT
STORMWATER MLANAGEMENTBMP PLAN
E STREAM BUFFER MITIGATION PLAN
Date of Application: March 19 2001
Project/Development Name: Townwood Mobile Home Park
Amount of Land Disturbance: 4.41 Acres
Tax Map/Parcel: Tax Map 61 Parcel 8
Zoning:
Location of Property: South st corner of the intersection of Rio Road West and
(Please be specific) H draulic Road
OWNER
CONTRACTOR
Name: Management Services Corp,
Name: To Be Determined
Address: P. O. Box 5306
Address:
Charlottesville VA 22905
Phone: 977-4181 Fax: 295-8025
Phone: Fax:
PLAN PRE PARE R
:Name: Kurt M. Gloeckner, P.E. ,P,L.S. lf1N3
Address: 2246 Ivy Road, Suite 5 J LLir tc )0C
Charlo t G ; 1 7 e A ,a,,, LL
Phone: 971 -1 591 Fax: 293-7612
BY SIGNING THIS APPLICATION AS OWNER, I HEREBY CERTIFY THAT ALL REQUIREMENTS OF THE APPROVED
EROSION CONTROL PLAN, STORMWATER MANAGEMENT/BW PLAN, AND/OR MITIGATION PLAN WILL BE
COMPLIED WITH AND I HAVE THE AUTHORITY TO AUTHORIZE THE LAND DISTURBING ACTIVITIES AND
DEVELOPMENT ON THE SUBJECT PROPERTY. I HEREBY GRANT THE COUNTY OF ALBEMARLE THE RIGHT TO
ENTER UPON THE PROPERTY AS REQUIRED TO ENSURE COMPLIANCE WITH THE APPROVED PLAN.
By: Ade/A4-- (
Iir 4,��F K U..L. Date: /e a4
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Owner
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Print Name: . `6
G QRS C. HTonl MAnq G
Title: L.;,... �Z .�,,,\;�-.; G^&.QA.►';e
PLEASE SEE REVERSE (Corporation,Partnership,etc.)
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APPLICABLE FEE MUST BE PAID AT TIME OF APPLICATION. Calculate fee below and make
check payable to the "County of Albemarle".
TYPE OF PLAN FEE
EROSION CONTROL PLAN: (SUBMIT 2 COPIES)
1. Plan for a Single Family Dwelling Unit $100
2. Plan for Non-Exempt Agricultural Land Disturbing Activity.... $100
3. Plan for All Other Land Disturbing Activity:
$250 plus 5100/acre of disturbed area or portion thereof
4.41 Acre(s) x$100 = $ 441 . 00 $250 = $ 691 . 00 NOT TO EXCEED $2,500)
4. Major Amendment of Plan $120
5. SUBTOTAL, EROSION CONTROL PLAN 5 691 . 00
STORNIWATER MAiNAGEMFNTBMP PLAN: (SUBMIT 2 COPIES)
6. Stormwater Management/BMP Plan $100
7. Major Amendment of Plan $ 75
8. SUBTOTAL SWM BMP PLAN $ 100. 00
STREAM BUFFER MITIGATION PLAN: (SUBMIT 2 COPIES)
9. Mitigation Plan 5 50
10. SUBTOTAL MITIGATION PLAN $ N/A c.
TOTAL APPLICATION FEE: S 791 . 00
(Add lines 5, 8 and 10)
THE OWNER SHALL BE RESPONSIBLE FOR ALL REINSPECTION AND/OR ANNUAL RENEWAL FEES
WHICH MAY BE CHARGED TO THIS PROJECT.
FOR OFFICE USE ONLY:
Date Filed � - IC1 --C I.I Fee Collected 5 Initials
Plan # . /3a